PDPM Claim-Processing Fix by CMS

CMS Confirms Some PDPM Claim-Processing Errors,
Promises Fix by October

The federal government on Thursday acknowledged some errors in processing Medicare claims under the new payment system for nursing homes, promising to make a full correction by the start of its next fiscal year.

The main issue has to do with the sequence of initial claim filings for Patient-Driven Payment Model (PDPM) reimbursements, the Centers for Medicare & Medicaid Services (CMS) announced in a release from the Medicare Learning Network.

SNF PDPM Claims Issue

Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) initial claims that are processed out of sequence are not paying the correct Variable Per Diem (VPD)-adjusted rate. Also, all adjustment claims are not processing correctly. Claims need to process in date of service order for each stay for the VPD to calculate correctly. We will correct this issue in October. In the interim:

  • Submit claims in sequence by waiting at least 2 weeks before billing subsequent claims
  • To adjust claims, cancel the initial claim and all subsequent claims in the SNF stay then rebill in sequential order; or, hold adjustments (when allowable) until October when they will process correctly
  • Submit a complete bill at the time of entry

ADL to Release FDB Targeted Medication

ADL is adding Innovative Medication Decision Support to provide Actionable Guidance for Clinicians

Using FDB’s Targeted Medication Warnings™ the ADL/EMR will be able to leverage patient-specific, contextual clinical information within the EHR to identify only patients that manifest prescribing risks, so that resulting clinical guidance is more meaningful, actionable and presented at appropriate times in the clinical workflow.

Clinical Guidance with a Patient-First Approach

Targeted Medication Warnings is the only commercially available medication decision support content that leverages situational context and patient-specific parameters. Rather than alerting on potential clinical consequences of the medication therapy, context-relevant guidance is provided when it matters most.

The benefits are significant because as the Order Entry’s clinical decision support can incorporates more patient context, such as lab values or clinical risk scores. Thus the Order Entry can provide more meaningful information to act upon. This new, more targeted approach is designed to reduce alert fatigue and deliver meaningful, relevant, and actionable guidance to improve patient care.